Expert consensus on the development of quality care measures for kidney cancer in Spain.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19180-e19180
Author(s):  
Vicente Guillem ◽  
Carlos Camps ◽  
Miguel Angel Climent Duran ◽  
Aránzazu Gonzalez del Alba ◽  
Martín Emilio Lázaro Quintela ◽  
...  
Keyword(s):  
Healthcare System ◽  
Kidney Cancer ◽  
Quality Care ◽  
Participation Rate ◽  
Quality Measures ◽  
Clinical Results ◽  
Nominal Group ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Oncology Practice

e19180 Background: To promote the continuous improvement of kidney cancer healthcare by proposing quality care measures (with respective indicators and standards) for its diagnosis, treatment and follow-up care that can be used by the corresponding professionals and that can be applied across the Spanish healthcare system. Methods: 1. a) Bibliographic review of international research (previous 5 years) on the quality of kidney cancer care; b) Multidisciplinary nominal group (9 oncology experts from the ECO Foundation –Excellence and Quality in Oncology Foundation – and 2 university methodologists – Francisco de Vitoria University Faculty of Medicine) to identify and select possible quality measures that can be applied in Spain; c) Modified Delphi Consensus (two rounds, remotely) by a panel of 55 oncologists subspecialized in kidney cancer, selected by a geographically stratified snowball sample. The ASCO (American Society of Clinical Oncology) /QOPI (Quality Oncology Practice Initiative) model is followed for the drafting of each item: definition of measures, indicators, information sources, exclusions, clarifications, categorization, acceptable standards. Results: The nominal group proposed 43 possible quality measures to the Delphi panel. Consensus participation rate = 84.5% (47 specialists). A unanimous consensus was achieved for 40 quality measures, grouped into the following areas: 4 structural, 33 regarding treatment process and 3 regarding clinical results. Conclusions: The level of consensus among Spanish oncologists subspecialized in kidney cancer on the proposed care measure for the management of said cancer is very high (93%). These results indicate widespread acceptance and applicability of said measures in the Spanish National Healthcare System and, with this in mind, they will henceforth be a valuable tool for the comparative evaluation of the quality and fairness of the oncological care of kidney cancer patients in Spain.

ECO Experts’ consensus on establishing renal cancer healthcare quality measures in Spain.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 220-220
Author(s):  
Vicente Guillem ◽  
Javier Puente ◽  
Carlos Camps ◽  
Miguel Ángel Climent Durán ◽  
Enrique Gallardo Diaz ◽  
...  
Keyword(s):  
Healthcare System ◽  
Renal Cancer ◽  
Healthcare Quality ◽  
National Health System ◽  
Quality Measures ◽  
Clinical Results ◽  
Nominal Group ◽  
Delphi Panel ◽  
Global Evaluation ◽  
Sources Of Information

220 Background: The ECO Foundation (Excellence and Quality in Oncology) proposes to establish a set of healthcare quality measures (including indicators and standards) for the diagnosis, treatment and follow-up of renal cancer in Spain which all healthcare professionals involved can assume, being suitable for implementation in the continuous improvement process of our healthcare system. Methods: a) International literature review on the quality of healthcare in renal cancer; b) multidisciplinary driving group (9 oncologists with expertise in renal cancer plus 2 methodologists) to identify and choose possible quality measures to be applied in Spain; c) global evaluation of the relevance of these measures through experts’ consensus (Delphi modified by a stratified state panel, n = 55 oncologists specialized in renal cancer); d) selection of definitive measures, according to their feasibility and efficiency (information provided/effort in obtaining it) using a quantitative online priority grid; e) standard wording of the chosen measures: definition, indicator, sources of information, exclusions, clarifications, categorization and acceptable standard. Results: The nominal group proposed 43 quality measures for the Delphi panel. Consensus agreement rate = 84.5% (47/55). The professional consensus was reached on 40 measures (4 structural, 33 in healthcare procedures and 3 in clinical results). Therefore, there is a high level of consensus (93%) among Spanish oncologists who specialize in renal cancer on the content of the healthcare quality measures in the management of renal cancer. The final measures were chosen using a high confidence level (95%) in the unanimity of the experts (oncologists in the driving group) for prioritization depending on the feasibility and efficiency in the healthcare system. Finally, 25 measures were chosen (2 structural, 20 in procedures and 3 in results). Conclusions: The level of consensus and prioritization of measures achieved, will most likely translate in a widespread acceptance and viability for implementation in the National Health System. This could provide a valuable tool for quality assessment and equality in the care of renal cancer patients in Spain.

scholarly journals Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways

2021 ◽  
Vol 9 ◽  
Author(s):  
Pedro Candeias ◽  
Violeta Alarcão ◽  
Miodraga Stefanovska-Petkovska ◽  
Osvaldo Santos ◽  
Ana Virgolino ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Online Survey ◽  
Sexual And Reproductive Health ◽  
Participation Rate ◽  
Delphi Panel ◽  
Structural Factors ◽  
Delphi Consensus ◽  
Good Practices ◽  
Migrant Populations ◽  
Governmental Organizations

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

scholarly journals Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

2021 ◽  
Vol 10 ◽  
pp. 216495612110210
Author(s):  
Eileen M Dryden ◽  
Rendelle E Bolton ◽  
Barbara G Bokhour ◽  
Juliet Wu ◽  
Kelly Dvorin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Technology Use ◽  
Care Delivery ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Veterans Health ◽  
Health Administration ◽  
System Transformation ◽  
Virtual Technology ◽  
Exogenous Shock

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

scholarly journals Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244485
Author(s):  
Caroline Verhestraeten ◽  
Gijs Weijers ◽  
Daphne Debleu ◽  
Agnieszka Ciarka ◽  
Marc Goethals ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Practitioner ◽  
General Practitioners ◽  
Early Stage ◽  
Blood Analysis ◽  
Care Process ◽  
Delphi Panel ◽  
Delphi Consensus ◽  
Heart Failure Patients

Aims Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. Methods and results The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Conclusions Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.

Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative

2021 ◽  
pp. 105566562110350
Author(s):  
Catherine de Blacam ◽  
Adriane L. Baylis ◽  
Richard E. Kirschner ◽  
Susan Smith ◽  
Debbie Sell ◽  
...  
Keyword(s):  
Core Outcome Set ◽  
A Priori ◽  
Delphi Panel ◽  
Core Outcome ◽  
Delphi Consensus ◽  
Assessment Development ◽  
Comparison Of Results ◽  
Outcome Set ◽  
Patient Reported ◽  
Panel Rating

Objective To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD. Design A two-round Delphi consensus process was used to develop the COS. Patients, Participants The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD. Interventions A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled “not important,” 4 to 6 labeled “important but not critical,” and 7 to 9 labeled “critical.” Main outcome measure Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS. Results A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD. Conclusions Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.

Lithuania

2021 ◽  
pp. 456-472
Author(s):  
Liubovė Murauskienė
Keyword(s):  
Soviet Union ◽  
Healthcare System ◽  
Quality Care ◽  
Healthcare Provision ◽  
Universal System ◽  
Health Politics ◽  
Healthcare Needs ◽  
The Soviet Union ◽  
Out Of Pocket Payments ◽  
Compulsory Health Insurance

This chapter examines health politics and the compulsory health insurance system in Lithuania and traces the development of its healthcare system. Since the country declared independence from the Soviet Union in 1990, Lithuanian health politics have revolved around restructuring and rationalizing the overcapacities of the inherited healthcare system, increasing levels of public finance to those sufficient to meet healthcare needs, and making good on the patient rights implied by a universal system. Despite those efforts, high out-of-pocket payments remain an obstacle to health solidarity, healthcare provision—which is predominantly public—is overly dependent on inpatient care, and public financing measured as a share of GDP remains low. As the chapter outlines, other issues include low levels of satisfaction with and trust in the health system and the persistence of informal payments to ensure quality care.

scholarly journals Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach

Rheumatology ◽  
2020 ◽  
Author(s):  
Seza Özen ◽  
Erdal Sag ◽  
Eldad Ben-Chetrit ◽  
Marco Gattorno ◽  
Ahmet Gül ◽  
...  
Keyword(s):  
Familial Mediterranean Fever ◽  
Nominal Group ◽  
Evidence Based ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
Health Authorities ◽  
Colchicine Resistance ◽  
Mediterranean Fever ◽  
Definition Of ◽  
The Impact

Abstract Objectives Colchicine is the main treatment for familial Mediterranean fever (FMF). Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. Methods A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and pediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. Results Consensus among the panel was achieved on 8 core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period), or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. Conclusion Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.

Developing and implementing EMR functionality to improve oral chemotherapy outcomes.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 159-159
Author(s):  
Thomas A. Hensing ◽  
Bruce Brockstein ◽  
George W. Carro ◽  
Ashton Marie Hullett ◽  
Brad Hughes ◽  
...  
Keyword(s):  
Anticancer Agents ◽  
Quality Care ◽  
Insurance Coverage ◽  
Team Members ◽  
Monitoring Tools ◽  
American Society ◽  
Oncology Practice ◽  
Documentation Tool ◽  
Similar Growth

159 Background: Approval of new oral anticancer agents (OAA) continues to rise, accounting for 75% of new oncology drugs approved so far in 2015. OAA prescriptions generated at our institution demonstrate similar growth, as the prescription volume for OAA is approximately 200% greater than it was 8 years ago. Challenges of OAA, including safe prescribing, monitoring toxicities, and assessing adherence, continue to be an obstacle to providing quality care. In recognition of these challenges, our institution employed the electronic medical record (EMR) to develop tools to enhance safe prescribing, monitoring, and follow up for patients receiving OAA. Methods: Comprehensive, regimen-specific, OAA protocols were built in the EMR using the American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria as a guide. Protocols included OAA prescriptions, laboratory tests, monitoring communications, supportive care medications, plan for follow up, and a monitoring order. The monitoring order, dated 7 to 10 days after the start of each cycle, was utilized to identify patients for follow up, and as a documentation tool. During follow up calls, pharmacists provided education, addressed adherence and toxicities, and communicated findings to team members. The initial analysis focused on six of the most commonly prescribed OAA agents at our institution. Results: Cycle 1 follow up calls were placed for 115 new start OAA patients. Over half of the patients (56.5%) required an intervention (ex: symptom management, alerting the medical team, counseling). Eleven patients had barriers to adherence (ex: confusion, incorrect technique, cost, obtaining insurance coverage, and toxicity). Overall, 98% of patients verbalized appropriate adherence. There were 191 subsequent follow up efforts, after the cycle 1 follow up call, which resulted in 39 interventions (20%). Conclusions: OAA requires the same intensive monitoring and follow up as IV chemotherapy, but is more difficult to provide given the nature of administration of these medications. Utilizing the EMR to develop prescribing and monitoring tools can help address these challenges by providing a means for enhanced documentation and follow up.

Improving the Medical Orders for Life-Sustaining Treatment (MOLST) form documentation process in an outpatient oncology clinic.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 299-299
Author(s):  
Jennifer Faig ◽  
Jessica A. Zerillo ◽  
Danielle Wright ◽  
Aya Sato-DiLorenzo ◽  
Michelle Mahony ◽  
...  
Keyword(s):  
Quality Care ◽  
Primary Objective ◽  
Physician Satisfaction ◽  
Administrative Staff ◽  
Oncology Patients ◽  
Convenience Sample ◽  
New Process ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
Oncology Practice

299 Background: Advance care planning is an important aspect of providing high quality care to oncology patients. ASCO Quality Oncology Practice Initiative (QOPI) recognizes the importance of advance directive documentation as a quality measure. MOLST forms are often completed to document a patient’s preferences for medical care at the end of life. The primary objective of this study was to improve the MOLST form documentation process in an outpatient solid tumor oncology clinic. Methods: We conducted a survey to identify areas for improvement and created a process map illustrating the complexities of the current MOLST form documentation process. A multidisciplinary team comprised of physicians, nurses, administrative staff, a quality improvement leader and a palliative care expert was created to focus on this initiative. We developed a new process whereby completed MOLST forms were uploaded into the electronic medical record (EMR) system. We implemented the following interventions: 1) made MOLST forms accessible to clinicians; 2) created a centralized location to place MOLST forms; 3) educated oncology staff about the new process; and 4) streamlined the MOLST form scanning process into the EMR. This process was studied during a pilot between January 22, 2018-February 2, 2018. A pre-pilot convenience sample was compared to pilot data. Results: Oncologists identified the need to improve the MOLST form documentation process on the pre-pilot survey. The percentage of completed MOLST forms scanned into the EMR increased from 44.4% (4 out of 9 forms) pre-pilot to 87.5% (7 out of 8 forms) during the pilot (p = 0.06). All of the MOLST forms completed using the new process were scanned into the EMR. Physician satisfaction with the MOLST process increased from 7.1% (2 out of 28 survey respondents) pre-pilot to 87.5% (14 out of 16 survey respondents) post-pilot (p < 0.01). Conclusions: A targeted process to enhance the documentation of completed MOLST forms succeeded and increased physician satisfaction. Further work will need to be performed to better identify oncology patients appropriate for MOLST form discussions.

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